1. Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression
- Author
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Guadalupe Pastor, Daniela C. Gonçalves, Antonio Rojas-García, Ignacio Ricci-Cabello, Isabel Ruiz-Pérez, Miguel Rodríguez-Barranco, [Ricci-Cabello, I, Gonçalves, DC] Nuffield Department of Primary Care Health Sciences, University of Oxford, Jericho, UK. [Ricci-Cabello, I, Ruiz-Pérez, I, Rojas-García, A] CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain. [Ruiz-Pérez, I, Rojas-García, A, Pastor, G, Rodríguez-Barranco, M] Andalusian School of Public Health, Granada, Spain., and Funding source National Institute of Health Carlos III (Study PS09/00747).
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Gerontology ,Autocuidado ,Endocrinology, Diabetes and Metabolism ,Ethnic group ,MEDLINE ,Psychological intervention ,Meta-regression ,CINAHL ,Diabetes Mellitus Tipo 2 ,law.invention ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Patient Education as Topic ,Randomized controlled trial ,law ,Diabetes type 2 ,Ethnicity ,Self-management ,Humans ,Medicine ,Minority Groups ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Self Care [Medical Subject Headings] ,Análisis de Regresión ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Regression Analysis [Medical Subject Headings] ,Disciplines and Occupations::Social Sciences::Sociology::Minority Groups [Medical Subject Headings] ,business.industry ,Systematic literature review ,Pronóstico ,Educational interventions ,General Medicine ,Grupos Étnicos ,Prognosis ,Educación del Paciente como Asunto ,Humanos ,Self Care ,Meta-analysis ,Systematic review ,Diabetes Mellitus, Type 2 ,Grupos Minoritarios ,Named Groups::Persons::Population Groups::Ethnic Groups [Medical Subject Headings] ,Regression Analysis ,Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Diabetes Mellitus::Diabetes Mellitus, Type 2 [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings] ,business ,Disciplines and Occupations::Education::Education, Nonprofessional::Health Education::Patient Education as Topic [Medical Subject Headings] ,Research Article - Abstract
Background: It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs’ characteristics associated with greater success. Methods: We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. Results: We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated. Conclusions: Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.
- Published
- 2014